Stafford v. Burns

• Decision Date: 29 November 2016
• Docket Number: No. 1 CA–CV 15–0476,1 CA–CV 15–0476
• Citation: 386 P.3d 398
• Parties: Dalton Scott STAFFORD and Kristine Major Stafford, Parents of Jesse Trey Stafford, Deceased, Plaintiffs/Appellants, v. Anne M. BURNS, M.D. and John Doe Burns, Husband and Wife; Empower Emergency Physicians, P.C., Defendants/Appellees.
• Court: Arizona Court of Appeals

386 P.3d 398

Dalton Scott STAFFORD and Kristine Major Stafford, Parents of Jesse Trey Stafford, Deceased, Plaintiffs/Appellants,

v.Anne M. BURNS, M.D. and John Doe Burns, Husband and Wife; Empower Emergency Physicians, P.C., Defendants/Appellees.

No. 1 CA–CV 15–0476

Court of Appeals of Arizona, Division 1.

FILED November 29, 2016

OPINION

JONES, Judge:

¶ 1 Dalton and Kristine Stafford (the Staffords) appeal the trial court's orders denying their motions for new trial and for relief from judgment following a jury verdict in favor of Appellees (collectively, Dr. Burns) on the Staffords' claims for medical malpractice and wrongful death after their son, Jesse, died of a methadone overdose.

¶ 2 The Staffords argue the trial court erred in instructing the jury, pursuant to Arizona Revised Statutes (A.R.S.) section 12-572(A),¹ that the Staffords bore the burden of proof by clear and convincing evidence because, they contend, Dr. Burns did not provide medical care "in compliance with" the Emergency Medical Treatment and Active Labor Act (EMTALA). See 42 U.S.C.A. § 1395dd (West). As set forth below, we hold, as relevant here, the heightened standard of proof for claims against a health professional set forth in A.R.S. § 12-572(A) applies whenever the acts or omissions plaintiff contends were deficient were provided in the course of evaluating and treating a patient in a hospital emergency department.

¶ 3 The Staffords also argue the court abused its discretion in denying their motion for new trial based upon various administrative and evidentiary rulings, for which we find no error.

¶ 4 Finally, the Staffords argue the trial court erred in imposing sanctions pursuant to Arizona Rule of Civil Procedure 68(g) because Dr. Burns' pretrial offer of judgment was invalid in that it was not made in good faith. We do not reach the merits of the Staffords' contention because Rule 68(g) contains no such good faith requirement, and we decline to impose one in contravention of the rule's plain language and purpose.

¶ 5 For the reasons stated below, we treat the Staffords' appeal as a petition for special action, accept jurisdiction, and deny relief. Accordingly, the judgment and orders are affirmed.

FACTS² AND PROCEDURAL HISTORY

¶ 6 In the early morning hours of February 5, 2012, Jesse presented at the emergency room of St. Joseph's Hospital after having ingested an unknown quantity of methadone. After several hours of testing, evaluation, and monitoring for a possible methadone overdose, Dr. Burns took over Jesse's care until he was discharged around 1:00 p.m. Jesse was found dead the following day.

¶ 7 In January 2013, the Staffords filed a complaint against Dr. Burns, asserting she negligently caused Jesse's death by wrongfully determining his condition was stable and discharging him prematurely. In response, Dr. Burns asserted she complied with the standard of care and presented evidence suggesting Jesse ingested additional methadone after his discharge that ultimately caused his death.

¶ 8 After a twelve-day trial, the jury returned a defense verdict. The Staffords timely filed motions for new trial and for relief from judgment, which were denied. This appeal followed.

JURISDICTION

¶ 9 This Court has an independent duty to examine whether it has jurisdiction to consider an appeal. Sorensen v. Farmers Ins. of Ariz., 191 Ariz. 464, 465, 957 P.2d 1007, 1008 (App. 1997) (citing Davis v. Cessna Aircraft Corp., 168 Ariz. 301, 304, 812 P.2d 1119, 1122 (App. 1991)). Our appellate jurisdiction is generally limited to issues arising from final judgments disposing of all claims and all parties. Musa v. Adrian, 130 Ariz. 311, 312, 636 P.2d 89, 90 (1981). A notice of appeal filed before entry of a signed final judgment or resolution of a time-extending motion is a nullity unless and until the final order enters. See ARCAP 9(c); Craig v. Craig, 227 Ariz. 105, 107, ¶ 13, 253 P.3d 624 (2011) (citing Smith v. Ariz. Citizens Clean Elections Comm'n, 212 Ariz. 407, 415, ¶ 39, 132 P.3d 1187 (2006), and Engel v. Landman, 221 Ariz. 504, 509, ¶ 13, 212 P.3d 842 (App. 2009)); Tripati v. Forwith, 223 Ariz. 81, 84, ¶ 15, 219 P.3d 291 (App. 2009).

¶ 10 Here, the Staffords filed two time-extending motions. See ARCAP 9(e)(1)(D) (motion for new trial), (E) (motion for relief from judgment). The trial court entered a signed order denying the motion for relief from judgment and denied the motion for new trial in an unsigned minute entry order. Although this Court re-vested jurisdiction in the trial court for the purpose of obtaining a signed, final order corresponding to the minute entry denying the motion for new trial, see Eaton Fruit Co. v. Cal. Spray-Chem. Corp., 102 Ariz. 129, 130, 426 P.2d 397, 398 (1967), no such order has been issued. Accordingly, we lack appellate jurisdiction over this appeal.

¶ 11 Although we do not have appellate jurisdiction, we may, in our discretion, consider the appeal as a petition for special action. See Grand v. Nacchio, 214 Ariz. 9, 17, ¶ 20, 147 P.3d 763 (App. 2006) (citing Danielson v. Evans, 201 Ariz. 401, 411, ¶ 35, 36 P.3d 749 (App. 2001), and Lloyd v. State Farm Mut. Auto. Ins., 189 Ariz. 369, 375, 943 P.2d 729, 735 (App. 1996)); see also A.R.S. § 12-120.21(A)(4) (granting court of appeals jurisdiction to hear special actions "without regard to its appellate jurisdiction"). We elect to do so here. The Staffords present at least two issues of first impression and statewide importance likely to recur. See Lind v. Superior Court, 191 Ariz. 233, 236, ¶ 10, 954 P.2d 1058 (App. 1998) (citing Moss v. Superior Court, 175 Ariz. 348, 350, 857 P.2d 400, 402 (App. 1993)). Additionally, were we to dismiss the appeal, nothing that may occur in the trial court would likely alter the disposition of the issues raised. Grand, 214 Ariz. at 18, ¶ 24, 147 P.3d 763. Not wanting to elevate form over substance, we exercise our discretion to treat this appeal as a petition for special action and accept jurisdiction but, as set forth below, deny relief.

DISCUSSION

I. Application of A.R.S. § 12-572(A)

¶ 12 A plaintiff must generally prove the elements of his medical malpractice claim by a preponderance of the evidence. See Harvest v. Craig, 195 Ariz. 521, 523, ¶ 10, 990 P.2d 1080 (App. 1999) (citing Thompson v. Sun City Cmty. Hosp., Inc., 141 Ariz. 597, 608, 688 P.2d 605, 616 (1984)). In 2009, however, our legislature adopted A.R.S. § 12-572(A), which heightened the burden of proving a malpractice claim against "a health professional ... who provides or who is consulted to provide services to a patient of a licensed hospital in compliance with [EMTALA]" to clear and convincing evidence. EMTALA is a federal statute enacted to address the growing concern that hospitals were routinely refusing emergency medical treatment to individuals unable to pay for services. See Eberhardt v. City of L.A., 62 F.3d 1253, 1255 (9th Cir. 1995) (citing H.R. Rep. No. 241, 99th Cong., 1st Sess. (1986), reprinted in 1986 U.S.C.C.A.N. 726-27); Scottsdale Healthcare, Inc. v. Ariz. Health Care Cost Containment Sys. Admin., 206 Ariz. 1, 6 n.6, ¶ 20, 75 P.3d 91, 97 n.6, ¶ 20 (2003) (citing Bryant v. Adventist Health Sys./W., 289 F.3d 1162, 1165 (9th Cir. 2002)). The Staffords argue the trial court erred in instructing the jury on the clear and convincing burden of proof set forth in A.R.S. § 12-572(A) because, they contend, Dr. Burns was not providing services "in compliance with EMTALA" as another physician had already performed the medical screening and determined Jesse did not have an emergency medical condition. In response, Dr Burns argues A.R.S. § 12-572(A) applies to "all emergency room services."

¶ 13 Although we review a trial court's denial of a motion for new trial and its decision to give a jury instruction for an abuse of discretion, we review de novo whether jury instructions accurately state the law. Delbridge v. Salt River Project Agric. Improvement & Power Dist., 182 Ariz. 46, 53, 893 P.2d 46, 53 (App. 1994) (citing Suciu v. AMFAC Distrib. Corp., 138 Ariz. 514, 520, 675 P.2d 1333, 1339 (App. 1983)); State v. Garcia, 224 Ariz. 1, 18, ¶ 75, 226 P.3d 370 (2010) (citing State v. Martinez, 218 Ariz. 421, 432, ¶ 49, 189 P.3d 348 (2008)); see also State v. Rios, 217 Ariz. 249, 250, ¶ 5, 172 P.3d 844 (App. 2007). The interpretation and application of statutes also present questions of law which we review de novo. City of Phx. v. Glenayre Elecs., Inc., 240 Ariz. 80, 84, ¶ 8, 375 P.3d 1189 (App. 2016) (citing First Fin. Bank, N.A. v. Claassen, 238 Ariz. 160, 162, ¶ 8, 357 P.3d 1216 (App. 2015)).

¶ 14 The heightened burden of proof of A.R.S. § 12-572(A) applies where services are provided "in compliance with EMTALA." EMTALA applies to any individual who comes to a hospital's emergency department for treatment.³ 42 U.S.C.A. § 1395dd(a). Under EMTALA, the hospital is required to provide appropriate medical screening to determine if an emergency medical condition exists.⁴ Id. If the patient has an emergency medical condition, the hospital must either provide "such further medical examination and such treatment as may be required to stabilize the medical condition," or, if safe and appropriate, transfer the patient to another facility for stabilizing care.⁵ 42 U.S.C.A. § 1395dd(b)(1). For purposes of EMTALA, a patient is "stabilized" when "no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from a facility." 42 U.S.C.A. § 1395dd(e)(3)(B).

¶ 15 The gamut of services that may be necessary to comply with EMTALA cannot readily be distilled into a universally applicable and finite list, and therefore, the phrase cannot be read narrowly. To adopt the Staffords' view, the burden of proof against the health care provider would shift from clear and convincing to a preponderance of the evidence the instant: (1) the screening process is completed and reveals the patient does...